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PostPosted: Thu May 27, 2010 2:37 am 
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Well, I've been cruising around this site a lot lately, I found it over a year ago when I first got on subox but came back to it recently, figured out how to navigate, learned a lot, and finally registered. I've been wanting to post for a little while but not sure what to say and feeling like my story is kind of long and complex. The suggestion said use the "introductions" section to talk about what we're proud of in our lives and save our addiction stories for elsewhere, but it seems like introduction is the place to start since i don't exactly have a straightforward question or opinion, except that I am really uncertain what dose I ought to be on. So I'll try to sum up my background and say where I'm at now--I was a heroin addict off and on (but mostly on) for about eight years, getting slowly but progressively worse. I finally stopped H for good in 2005 and then I couldn't have got any if I tried, but I never would try too hard even at my worst--never had the street skills to go out and get it if I didn't already have a connection I knew. So no more H after 2005 but I drank heavily for a long time as asubstitute, then around 2007 I just got tired of drinking and got a lot happier, or maybe the other way around. But once in a while around 2008 a friend started giving me methadone in pill form. I'd take it if it was available, until it ran out, never had enough to get addicted, and it was never around too often either. Then in late 2008 I found out someone at my jobsite was using H so I started using off and on, but very little at a time, my tolerance was so low I could get high from doing almost nothing. Still I knew I was skirting the edge of getting addicted and that it would only get worse, so feeling desperately scared I went to see a psychiatrist to ask for help. I also have a personal and family history of mental illness--for me mainly depression, of the severe and chronic variety, but also mood swings, anyone ever heard of cyclothymia? kind of like a milder version of bipolar....Anyway I think I might have that although I've never been given that as a formal diagnoses as far as I know. So I told the psychiatrist as much of my story as I could in the time available and was completely honest with her. She prescribed suboxone--I'd never heard of it before. She said it's not like methadone, and you won't get addicted, it just blocks opiates. I told her I wasn't sure I needed it, since I wasnt' quite at the point of addiction to H, but she said why take a chance, go with the suboxone. She presribed me the 8/2 mg tabs and told me to take half a tab a day. She gave me a prescription for 30 tabs with 3 refills. She also reccomended an evening rehab program, which she is the medical director of. No induction or anything else, I don't think she even asked me when the last time I used H was, didn't say anything about should be in withdrawal or don't use for a certain # of hours before starting the suboxone and never discussed how much or how often i was using H. I never heard of an induction until reading posts on this site. so I got some more H that day and waited until I ran out, then immediately started the suboxone. I also went to the rehab program she reccommened with high hopes, but it did absolutelly nothing for me, was very close to a complete waste of my money and my energy. But the suboxone--it sure cured my cravings but I felt my thinking was impaired, I felt kind of dizzzy, really I felt pretty much high. That was on 4mgs. I called the doc and told her, well, it works for the cravings, I don't want to use but I feel really imparied. She seemed surprised to hear it and reccomended I go down to a quarter tab, that is 2 mgs. I did and felt the same. I told the counselors at rehab too, that i felt high on the subox and that I wasnt' sure it was good, since I had not been fully addicted to the H. Plus I was having bad mood swings, crying and some rages too but not too overt. But, it seems to me, rehab can do that to some people, make us angry and sad. The one counselor just said well, give it a couple of days, the other counselor said "so it's making you feel a little woozy?" and that's all. Also I couldn't sleep at night, just sat up nodding all night, just like on H and got headaches like when I would do much H. But I kept taking the subox and it did cure cravings for H and I didn't use H for a while. Three weeks after I started I went back for a follow up with the psychaitrist, told her how it was going. At this point I hadnt' used H at all, had quit the rehab already, and was still feeling high on the sub at a half tab (4 mgs) a day. I told her and she said he thought it was a mistake to prescribe me the subox and told me to taper myself off, but nothing about how fast or slow or gradual or specific amounts, how much to reduce at a time, etc. I said ok but then I couldnt' do it. I just kept taking it every day. After a while it stopped getting me high though and so I started using H off and on again. And taking more sub too, to try to get high. At first I could take and extra half a tab and feel it, but after a while, I guess I finally hit that ceiling effect (though I'd never heard of the ceiling effect). And it got so I couldn't really get high on H either but I kept using whenever I could get it anyway. I found that if I used H for about 3 days running, and didn't take any subox, by the third day I could start to feel the H. See now why the title to my post? so I started taking more subox, but usually only a half tab (4 mgs at a time) and never more than a tab a day. and still using H off and on, and ran through all my refills. Then I went back to the psychiatrist and told her, well, I didn't stop taking it and the suboxone does help and I think I'd better stay on it. I wasnt' honest about my using though, I was afraid to tell her the whole truth. She said, well, if it keeps you off H you should stay on it for now but suggested I try to taper down to the lowest dose possible. So she gave me another 30 tab script with 3 more reffills. I just kept using H off and on and upped my sub dose even more. Still hoping to get high off the sub, but can't anymore. And never taking more than 2 tabs a day max, or maybe on a couple of occasions 2 tabs and a half. Ok, if anybody has read this far, now do you agree with my title? Ran thru my script and 3 refills in about 4 months this time, called in the script to the pharmacy anyway, pressed 1 to have the pharmacy call the doc for authorization and called back to find out she approved and they filled it, picked it up and saw that it has 1 refill on it. Now my situation is changed because my source for the H isn't gonna around all the time anymore and hopefully I can keep from seeking it out and actually use the suboxone the way it should be used finally. And/or ultimately taper off the suboxone. So now....I just wonder what dose i should be on. Lately I've been taking a little in the morning ( a quarter to a half tab) because I wake up feeling cold like withdrawal's starting but I dont' even know, maybe it's just cold in the morning. I have just been using the subox or h all the time and never really gotten past jsut the beginnings of the withdrawal. Before I saw the doc teh third time, to tell her I'd stayed on it instead of tapering off like she'd told me to, I was starting to have soem withdrawal--mostly night sweats and poor sleep, but I dont' even know if it was subox or H withdrawal, I'd just been using one or the other, one or the other, off and on, off and on. She gave me the refill , I went straight to the pharmacy and was fine within half an hour of taking a half a tab. So now, I take a littel subox in the morning, like a quarter or a half a tab and later in the day I take more, usually about 2 more half tabs 1 at a time a couple of hours apart, by afternoon. Then if I feel really bad in the evening I might even take another half tab. But I wonder what dose would be best, now I'd really like to try to do it right and be consistent. I'm thinking try to take the lowest possible dose is the best thing, right? maybe just a quarter or half tab would hold me fine. Anyway, I'm embarrassed to tell teh doc the entire story, would rather be somewhat stable before I talk to her, and would rather wait a bit before my next apointment also, due to the cost of the appointment. I know this is long, and I guess it might fit better in the category of "still messing around' or "dosage issues' but it's my first post and introduction. I saw about the online meeting but can anyone tell me what the meetings are exactly? Is it an online 12-step or more just a scheduled time for live chat? Agenda and topics or just what people bring to the table? And it seems like people post back and forth a lot but I never see anyone on chat. I dont' have many people at all (hardly anyone ever) I can talk to about what I'm going through and I remember the counselor saying she thought I really needed to have support. I've never got into 12-step or othre kinds of recovery meetings. I'm not against it on principle but never felt it was helpful to me either. One friend of mine when I told him about my relapse last year basically sent me a hate letter and told me to "submit" myself to whatever process I was supposed to the "just get help" spiel. I dont' want to knock 12-step or rehab, I know people do find help, but I havent', and have found it's all the same. I know suboxone can work if I use it right, and the main thing for me has been that I'm ok as long as I'm not around H. So I'm lucky now, this is my chance to get away from it because it wont' be at my jobsite any more now. Anyway, I know this is long, maybe no one could make it all the way through, but seems like moderators usually respond andn I have been wanting to post and see if I could connect with people on this site. And thanks to everyone who does post and to Dr. Junig and others who keep up this site, I have really learned a lot here. This wasnt' the best essay I've ever written here, but...though I may be a pathetic self-inflicted idiot victim....I'm not really illiterate.....Btw, regarding my psychiatrist, she seems to know surprisingly littel about suboxone, especiaally considering she has a lot of experience with addiciton treatment being the medical director of a major well-known and highly thought of rehab....I don't mean to say ill of her at all though, i really like her and she seems really intelligent, just, she admitted she is still learning about the suboxone, but.....on this site there is so much more talk about correct dosage, how to taper, withdrawal, etc. whereas my doc really just said try these pills, you won't get high, you won't get hooked, adn then when I said I felt high just said well take less, then later, "I think it was a mistake to prescrivbe it to you, maybe you should taper off" and then later "if it helps, stay on it." I am just surprised that she seems to know so little about dosage issues and also about how discontinuing might be difficult, everyone else seems to say it's usually pretty hard to get off subox.


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PostPosted: Thu May 27, 2010 6:45 am 
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I would find a new Dr. and stop being an " idiot " .. Time to get serious about this shit..... Your going to have to work on being patient also, Good Luck, Mike


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PostPosted: Thu May 27, 2010 7:56 am 
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I read your story.....the whole thing :-) Thanks for posting and I am glad you finally registered and decided to try and connect with people in the same situation as you. It has made a great difference for me in a positive way and I feel so much less alone than I did when I was on sub before. I also feel like I have learned a lot and have a little more control and understanding of my situation. I hope you will keep posting. This is going to be a process for you. Those who have gone back and forth with sub and H seem to have a very hard time.

In my opinion (I am not a doctor) it was a good medical decision to prescribe you suboxone. I do NOT think it was good medical practice to do so without urine tests and regular appointments or discussion about what you "plan" would be. As you know by now from experience and from reading on the forum, suboxone is only a tool to help you with your addiction. It will not cure you all on its' own. I highly suggest you find some type of support system. Being on here is a start. Read, find people you think you connect with, post publicly back to them, send them a PM. Start getting to know people a little. Create your own threads like you did here and give updates on your situation. Even if no one responds (very rarely does that ever happen) it gives you a time and place to think about your recovery and whether or not you are on track. There are online smart recovery programs and other non-12 step programs for recovery. If you don't connect with the 12-steps, you could try that. I also highly suggest getting into a therapist to discuss your issues. You need to identify what caused you to use in the first place, what your triggers are, how to identify them, etc.

In terms of your dosage, I think you really need to make some adjustments. First, you should really be taking your sub ONCE per day. Because of the half life, you should be able to do that so long as you are over about 6mg without getting any withdrawal in between. There is no way I can tell you what dose to be on. I would suggest trying 8mg in the morning and when you start feeling less than wonderful in the afternoon or evening, ride it out and document what you are actually feeling. If you think it is actual withdrawal, look at your pupils in the mirror. If they are of normal size and react to light, the withdrawal is probably psychological. If they seem much larger than normal and do not react to light, it is probably withdrawal and you should consider increasing your dosage. If you keep dosing multiple times per day, you will never break the habit of taking a pill every time you don't feel wonderful. Once you get on the right dose, you can learn to manage those feelings and eventually, they pretty much go away and even when they don't, you will become very confident in managing them without any pills.

Clearly the best thing to do would be to come clean with your doctor and discuss what has gone on so you can do this under a doctor's care. I also realize how scary that can be especially after this much time has passed. Again, I am not a doctor and these are only my opinions based on what you have said to me. Someone else may very well have a different opinion on the subject for you. I am glad you are here though and wish you the best. Keep posting.

Cherie


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PostPosted: Thu May 27, 2010 8:22 am 
Hello and welcome. I don't think you're pathetic or an idiot. You're an addict. As convoluted as your story may seem, it is essentially the basic addict story. You mess around, you mess around more, you get hooked, you stop on your own, you use a different substance, you start recovery, you use and do recovery at the same time, etc. etc. I've done all of the above. I've also tried to use suboxone, stop, use drugs, go back on suboxone, go back on drugs... As you're finding out, it doesn't work. You have to choose one path or the other. You probably should find a new sub doc (if possible), but just to give you the basics: You can't take sub "as needed" (and you cant take more to get high). You have to dose once a day (some docs say twice) at the same dose every day until you reach a steady state where you no longer "feel" the sub, yet you don't have cravings. I'm not a doctor, but I'm guessing you'd be OK at 4mg/day, since your not coming off a hard core habit. A dose too low won't get you to the ceiling level, where you're at steady state. However, you really need a doctor to help you find the right dose. It sounds like in addition to your doc not knowing much about sub, she doesn't give you any accountability by giving you three refills and not seeing you for four months.
I don't have time to write more, but I wish you the best. I hope you give sub a fair chance by using it properly w/out other drugs for a few months - and then you can make a judgement about it. Good luck and keep posting.
Lilly


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PostPosted: Thu May 27, 2010 9:13 am 
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I agree with the need to dose only once a day. It's necessary, like others have said, to stop the knee-jerk reaction of popping a pill when we feel bad. Suboxone has an average half-life of about 37 hours, so dosing once per day or even every other day is the norm.

It's sad to say, but your doctor isn't the only one who doesn't know enough about sub. Unfortunately, the pharmaceutical company that makes it is smaller and apparently hasn't used enough resources to educate the medical community about the way suboxone works.

You asked about our meetings. I don't consider them 12-step meetings at all. At the opening of each meeting (and we just started having them this week) we deal with any crises any members may be having, then we move on to the topic. This past Monday meeting's topic was "shame". We try to work through the topic and support each other on that subject. You're of course encouraged to attend. Our next meeting is this afternoon at 2 pm EDT. We use the "Meeting Announcements" topic to post the schedule and reminders.

I would also encourage you to see your doctor sooner rather than later to get on a stable, once-daily dose. We're so glad you found us and decided to post. But please, don't keep calling yourself an idiot, OK? You've been through a lot and you're intent on staying in recovery. That makes you pretty determined and strong in my book and anything BUT an idiot.

Hang in there and let us know how it goes.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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PostPosted: Thu May 27, 2010 9:55 am 
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:roll: autononymous,
I read through your post and I don't think you're an idiot at all. In fact if taking a substance at one time made you feel high it's perfectly logical for you to try taking more than prescribed. Now I'm not endorsing what ended up happening but if you weren't given much information on a new medication: such as how, when, where, and why to take it then it doesn't seem unlikely to me that some problems would occur. I really am sorry about your doctor and even though I'm sure she's a nice person like you suggested it really kind of blows my mind someone would prescribe the medication to patient without knowing to ask important questions about when the patient last used, how much, of what, etc? Anywho let me get to the points I wanted to make about what I would do if I were in your situation.

First off I would make taking the medication once per day my priority at the same time prefferably and I'd also be sure to take it the same way (if I typically let the medication dissolve under my tongue for 40mins then I'd make sure that I'd dose the same way all the time. Also by using a method that Dr. Junig has suggested by which grinding/chewing the medication into a powder with one's front teeth starting with a fairly dry mouth I would then be sure to not swallow any of the powder and then begin using my tongue to paint the powdered Sub tablet and saliva mixture all around the interior of my mouth (under the tongue on insides of my cheaks, the roof of the mouth, etc) over and over again for 30-40 mins. After the 30-40 mins I would then either spit out the remaining powdered tablet and salive goo or swallow it as either way what is left is essentially useless as the active ingredient in Suboxone, buprenorphine is subject to very high "first-pass metabolism" basically meaning that if the medication is swallowed without having already been given time to be absorbed orally or through any other mucos membrane only very negligible amounts of the medication are absorbed. After spitting or swallowing he (again Dr. Junig) suggests not eating or drinking anything for around 20 or so minutes to allow whatever is left of the medication in the mouth to absorb without being washed down into the stomach after eating or drinking. It took me a little work to get comfortable with the process but I've talked to plenty of others who use the same method.

Another suggestion I would think about if I were you would be to find someone you're close to who can say no to you and you can trust and have them hold onto the Suboxone prescription and only give you the amount you're supposed to take daily and if I absolutely couldn't find anyone else I would try very hard to try and get down to one dose a day on my own. I have to agree with what others have said so far about one of the primairy components to be able to get/stay clean is getting rid of the old patterns of active addiction where one is always asking themselves "how do I feel right now? I know what might make me feel better..... I'll go take another pill....yeah that will help" lol or that's what active using is about in my humble opinion.

Anyways I need to start getting some work done here.....hella lame part though is Friday still a day......come on weekend! Hope to see you posting again soon autononymous :wink:

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PostPosted: Thu May 27, 2010 10:09 am 
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As addicts it's easy to beat ourselves up, but the fact is, you wouldn't tell a cancer patient they're an "idiot" nor would you tell someone with diabetes they're an "idiot" so I would suggest you remove that type of language from your vocabulary when talking about yourself. You have an illness that manifests itself in some pretty destructive behavior, and left untreated it could eventually kill you. Thinking of yourself as an idiot is really just going to exacerbate your illness, because it feeds the behavioral cycle that contributes to the problem.

You're not an idiot. You're just sick.

I would urge you to find a doctor that actually understands what suboxone is, how it works, what the side effects are and how it should be used. From what you've posted here, your doctor seems relatively clueless.

Did I mention that you're not an idiot? Seriously...don't do that to yourself, it's not worth it.

I hope you'll stick around. I'm also a former heroin user, so I can relate to your struggle....although I think anyone who has abused opiates is in the same boat as a heroin user.

Hang in there, and stick around.


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PostPosted: Thu May 27, 2010 11:31 am 
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Wow, thank you all for your replies. I think it's all pretty good advice to me but I can't say I know what I'm going to do. I think being completely honest with my doctor is a good idea but of course I don't WANT to do that because it's really embarrassing and also I am afraid she might just be unable to trust me to be honest now adn from now on. Getting a new doc might be difficult. Also, I have had good raport with this doctor, the only problem has been that she somehow doesn't seem to know a lot about suboxone. She said herself she is "still learning." Actually I probably ought tell her everything in order to help her understand more about how suboxone works. It may also be she just didn't quite understand where I was at when I first came in, even though at that time I was completely honest. Still though, as I said there was no kind of inducton process at all for me or requirement that I be in w/d or any of the other stuff I've read about here. Anyway I might be able to make the meeting tonight, as long as coming in late isn't considered disruptive in onine meetings. Getting online support seems like an option that might work for me, at least I'm interested in trying it and I guess that's good. I'll post again when I have something to report, but for now I really just want to give a big Thank You to all of you who took the time to read and respond to my post, everybody seems really thoughtful and sincere and I really appreciate that and do feel a lot less alone now. And you are right of course, my story is a lot like a lot of other stories, adn my behavior with the subox really isn't surprising, and I'm sure I am in the same boat as a lot of other people. At least I'm lucky enough to have the chance to try subox, hopefully I can start using it appropriately now. Right now I feel really uncertain, I took some methadone pills (yes that came around again) yesterday even though I'm not sure I felt anything at all from it (becasue of my tolerance with subox (or ceiling effect) and /or my tolerance with H which I have also done less than a week ago. I don't think I feel any w/d, not even colder than usual, and even though I didn't feel the methadone I wonder if I should wait until I feel some w/d before going back on subox. My usual behavior would just be to take some subox first thing in the morning, but I'm trying to make a change here, adn also, I'm so uncertain about dosage. meanwhile, I will really think about whether or not I can bring myself to tell the truth to my doc....I would really like to but it's really hard. Getting a new doc, like I said, might be difficult and probalby more costly, at least for first visit, which cost IS a big concern for me. ONce you are in a lie, it's harder to get out of it than telling the truth from the start would have been....I really prefer to honest and usually am, which is why I mention the methadone despite fear that people here may jsut think (with reason, I admit) something like "you just arent ready" and meanwhile please don't waste our time with your using stories." Anyway, at least I'm being honest with someone here, and trying something new by getting on this site. Again, I do appreciate all of your comments very much.


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PostPosted: Thu May 27, 2010 7:45 pm 
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If you're going to honestly try suboxone, you really do need to put down the other drugs, including methadone.


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PostPosted: Thu May 27, 2010 8:15 pm 
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Even with suboxone , things are NOT a cake walk.. You get to a point where pills wont keep you happy anymore, sounds like your there.. You cant turn back , sorry.. Time is so precious, Mike


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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